>> good afternoon, council, marc trotz, housing and urban health. thank you, raj for that sweet introduction and comments. i feel really happy i get to be here today. i've come to the council, i don't know, half a dozen times probably over the last 22 years that i've worked for the city so it's just great that the stars aligned in my last couple weeks i get to come back one more time to see you all and share what we're doing. i also want to just formally introduce you to margo antonetti, she's currently the director of housing and urban health and in a couple weeks will be the acting director. everything i'm going to describe today has really been a partnership as well with margo and raj and other people. i came to the department from the mayor's office in 1996 and

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margo was the first staff person we hired so it's really been a joint effort, 100 percent, really. so you are going to be in great hands with her. we did a powerpoint presentation to our health commission a couple days ago, so i brought that with me. i don't know what the protocol is for projecting it, but here's hard copies for you guys if anybody wants them. >> (inaudible). >> yeah, i planned to do that, this is just something for your record. so much of what raj was just talking about was very much true for san francisco, that many years ago when the supportive housing movement had just started and the idea that you would do housing with support services to help people stabilize in housing, people who have been homeless, people

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with disabilities, san francisco jumped on that. and we had been doing it for maybe half a dozen years or so, but i think we were, like many other places in the country, still in that old mold and still kind of fresh off the sheltering experience and so forth. and while we were saying we were doing homeless housing, we were, you know, weeding out and screening out the very folks that needed to get into housing. and so that's actually when sort of coincides with me coming over to the health department and colluding with the then-director, sandra sanchez, saying what do you think you're doing with your supportive housing. i don't see our people in the health department who are chronickly cycling through emergency care getting into this housing and that really got our gears thinking and sort of changed

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our headset on what we were trying to do and that's when we pulled together probably hundreds of stake holders, i still remember these meetings, it was very exciting, it was like what if we would do housing that's totally different from what we have in town now, what would it look like, who would get in and who would be ineligible. that's what we came up with and birthed direct access to housing, which is just our brand name for supportive housing in san francisco. we were like how do you do housing that you can actually let people in. so that's what we tried to do. and at that point, you know, the mainstream housing developers, the affordable housing producers which this town has many incredible affordable housing producers were well-known for as small a town as we are the number of

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good housing, affordable housing producers, they weren't at all convinced that having people who had been homeless for 10 and 15 years and who have 3 and 4 chronic health issues on top of it were appropriate for housing. so we took the step at that point of sort of putting them off to the side and saying, okay, this isn't going to work, you don't want to house this population and we master leased a bunch of buildings. that's really how we got our start, we master leased the very first building that we did, we still is, pacific bay inn, 84 units on jones street. we were able to fill up that building with this new target population in a couple months as opposed to 5 years sort of the process of developing new housing and convincing everybody that we could house the people we were aiming to house. and then we just went on a roll from there and leased 5 other hotels in the tenderloin,

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names that you probably know, have visited people in and so forth, the windsor hotel, the empress, the plaza -- not the plaza, that's not master leased -- the star, the camelot, and before we knew it we had 450 units of what's now known as housing first type housing. and it was all experiments and we i'm sure made many mistakes along the way, but we were very gratified that we were housing folks who had traditionally been not able to get housing. along the way we had some learning in terms of what it takes and what the support services really should be in the housing. and up until that point, really the notion was you just had a couple kind of case managers and everything would be okay. and that was an understandable, you know, beginning to supportive housing

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because it was a reaction against more institutional care so we didn't want to recreate skilled nursing facilities and so forth in the community, but as we got into it more and realized what we could also do additionally with more enhanced health care services on site, we really began to hit our stride more and really see how you could stabilize people in housing and so then we hooked up with dr. josh bamburger, the medical director of our section. we started introducing, you know, some nursing hours within the building so we could do medication adherence, so we could do wound care and so forth, then we layered on some psychiatric care in our buildings and then we opened up a clinic in the neighborhood that the residents of supportive housing have very easy access to. so that was kind of our journey. as we worked through this, the housing development community was beginning to see that actually in fact we can

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support people in community-based housing this way and we sort of reconnected with them and probably maybe 8 years ago we started doing these really fabulous new buildings, which is what we -- what people want, not the new, but the high quality housing. admittedly our master lease buildings aren't the most beautiful sites in the world and in some of them they don't have cooking facilities and don't have accessible bathrooms and so forth. they are important and we're housing 400 people in there who otherwise wouldn't have housing, but reconnecting back with the affordable housing community then allowed us it really do the kind of housing that i think is healing and helps people really relax and come home and start a life and cook and reunite with their family and so forth. so really in the last 8 or so

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years the buildings we've been focusing on are these studio units or one-bedroom unit apartment complexes that look and are as nice as market rate housing all over the city. some examples of that, our most recently opened building is the richardson apartments, which is right behind this building, i love the symbolism of that, we have 120 units of chronickly homeless housing, i don't like that label but it's what it is known as, but it's housing for people who have not had any stability for many years. while we got our start talking about housing for homeless people, that's not really our, you know, our slogan any more. it's really housing for people who have been homeless, who are in levels of care that they no longer need, aren't appropriate for them, aren't the best for them, are high utilizers of

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health care services and if they don't get housing, as the literature shows, will be dead in their 50's. that's what this housing is about. so the richardson apartments, if you haven't seen it, is that beautiful building, i think, if i'm oriented correctly, that has that big green, lime green column. inside it has this amazing court yard, it has tremendous accessibility and light and the units are beautiful. i'm just going to look at my chart for a second to give you an idea how many units we have. we have, like, 30-some odd sites now and with the richardson opening it's about 1300 units that we have added. now, not every building is 100 percent direct access to housing site. we have a lot of sites that are 100 units or a

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few sites, 100 units with 20 of the units being direct access to housing with the rest of the units being straight-on affordable housing, which is a very nice mix. 990 polk street up at 9th and geary, owned and operated by tndc is roughly 100 or 110 units with 50 or 60 -- and these are all seniors, people over 55, actually -- of them being daas. so you have formerly homeless seniors, people who have been in laguna honda living with other folks who may still qualify for affordable housing so have more means, but also have aging issues and other service needs that the building addresses. so when we do services in these buildings it's not just

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exclusively to direct access to housing tenants. the access points, just to give you an idea who gets in and where we are looking for people, access into direct access to housing is through acute and psychiatric hospital, long-term care, so laguna honda and other places, intensive case management programs that work in the community, our primary care clinics, our sobering and respite center and our fabulous street outreach program. one of our biggest clients and trusted partners. and, you know, the reason we do this and the health department is doing this is, one, because we think it's the right thing to do and we have spent so many dollars and so many years spinning our wheels with trying to help people

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recover, only to realize the obvious, that it's ludicrous to do it without housing. how does someone recover from chronic health issues in a shelter on the street. it's not even possible to any degree. and so that's sort of the, i think, the bottom line where the health department is interested in doing it. and there is a financial argument about this, too, that many people have made, many national researchers and so forth with made, and there's huge studies that come out of new york city and upenn and so forth that demonstrate over and over again it doesn't cost any more to house someone in supportive housing than to leave them homeless when you factor in the hospital care costs, the ambulance costs, the jail time costs and so forth. and those aren't easy things to just neatly unravel and get

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the jail to start giving us all their money and the hospital to start giving us all their money. it's not as simple as it sounds but when you do look at that, that is the fact that in many cases it doesn't cost any more to house someone decently in housing than to leave them homeless. and if you just look at what our average cost per month to house someone in supportive housing, it's about $1500, and that equals -- that's one month in supportive housing, or two days at san francisco general hospital inpatient, less than one day in the icu, 3 visits to the ed, and 5 days in residential drug treatment. and in many of these places, well in almost all of those, even when you do incur all those costs, the person is still homeless afterwards. it's not like, okay, we have them in icu for 3 days, we're all set, they have somewhere to

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go. so really what we see and what a lot of the effort of the health department is to tray to intervene in that, you know, really harmful to the client and expensive ricocheting through the system and never really landing anywhere. some of the other sites, it works better when you are showing them up on the screen but we're just going to have to visualize for a second here. in case you've seen them and wondered about them, these are more recent sites i'm pointing out like in 2010 the 149 mason street site, it's owned by glide, it's got that ceramic mural on it. 55 units, beautiful housing right on the edge of union square. so people come out of their apartments, hopefully they head that way towards union square versus the other way towards the tenderloin and they can sit and enjoy san francisco just

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like everybody else does. other, you know, sites that we're particularly proud of, edith whit senior community is a direct access to housing site right there on 9th and mission street. it's 107 units, 27 of them are direct access to housing. the reimagine coronet theater which is now housing on gary street, big housing complex, a proportion of those are direct access to housing. armstrong in bayview, it's 116 units, 23 of which are direct access to housing. and our blockbuster that's in the pipeline right now is the ymca at 220 golden gate. almost everybody in san francisco has

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done something in that building since the early 1900's. a lot is basketball, some is dropping people off at the children's center that was there forever, and so forth. and this is going to be by far the largest supportive housing that the city's ever done. it's also, i think, one of the most impressive and interesting buildings. it's going to be opening at the end of this year. it's a 6-year project, it's a 90 million dollar project so i think that says a little something about the city's commitment to supportive housing. it's going to be 172 studio units, fully accessible all throughout the building. it's going to have an 11,700 square foot health clinic, the department of public health health clinic on the ground floor. it has a full court gym on the fifth floor that we're

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keeping because physical activity and wellness and space to just be is at such a premium in the tenderloin, we didn't want to get rid of that. everyone thought we should cram more housing units into that space and we thought, no, we need this recreation space. so we have that. it has a 200-plus seat historic auditorium that the community can use. many people know that auditorium, wait till you see it again now that it's been restored back to its original historic look. it's quite something. and full complement of support services for the tenants who are living there. so the health clinic is a community health clinic and then it's also going to have the support services for the 172 residents up on the second floor around this kind of light court. it's really something. i

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think we're all really proud to have been a part of it. tndc is the owner with a lot of coordination and collaboration with the department of public health, the mayor's office of housing, tons of state and federal agencies are part of that mix. and really that, i think, is the direction, you know, we want to be going. you can't always come across a building of this scale but the building will be very alive, very vibrant, there's a lot of con gregant space where people can hang out and get coffee. a lot of this is about helping people not just get housing but have a life and have neighbors and friends and i think this building is going to provide a lot of that. it did have a pool, which i really wanted to keep, but we weren't able to in the ground

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floor. it's now this humongus space -- no, it's a preserved pool. some day the covering will be taken off and the art deco pool will be found, short of being able to keep it there as another recreational opportunity for the people in the building, we couldn't because of the earthquake issues and safety issues and so forth. it's now, it's just huge recreation -- multi purpose room. so you could probably have a meeting of 500 down there, you know, with av and all of this kind of stuff. so the whole thing i think will be quite a resource for the central city area. and that's what we're really up to.

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we've got about another four or five hundred units in the pipeline, including this really fantastic unit that will be springing up soon or starting to spring up in the new transbay area. the first building to come up in the area of the demolished transbay terminal and the housing area is a direct access to housing site, another 120-unit site, owned and operated by the agency that ownd richardson so it should look every bit as nice as richardson and the services should be every bit as good, and some other buildings sprinkled throughout. so that's what we're up to. i hope and i know that under margo's leadership and all of your advocacy that the city will continue to produce these types of sites. it's been a pleasure talking to you guys. >> thank you, marc, do we have any questions from the council?

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ken? >> while we're waiting for the council to weigh in if they have questions, one thing that you brought to mind that i had forgotten, just to let people know what an incredible facility richardson is, that was the one i had the pleasure of visiting, the architect for that were the same people who did the ed roberts campus. so you know these guys aren't skimping. the other thing was that, as someone who had adult life long issues with environmental concerns, to see that nobody had to tell them to do non-voc stuff, two years ago i didn't even know there was carpeting that didn't off gas and they have it in little squares so if there's a problem they don't have it reduce the whole carpet, they just replace the square. that's the kind of

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attention to hidden disabilities that i appreciate myself. >> harriet. >> hi, good afternoon, thank you, mr. marc trotz and dr. raj parekh. you said no id's were required. i'm wondering since the people are from different backgrounds, different history, different medical needs, how do you prevent harm to another client and would there be like a resident advisor in the same building or on the same floor and especially in these older units also would there be elevators and any type of security? >> well, we can answer from

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both of our perspectives. in the housing, all the sites have 24 hour desk clerking and especially in neighborhoods where we feel like the straet activity would require that. strangers can't come into the building. this is a person's home. when people get housing, permanent housing, raj was talking more specifically and he can elucidate more on the stablization rooms, but with the housing, people don't get into housing without providing some documentation and a application process because we have to be sure it's going to work and it's a community building process. we're not taking this information to screen people out, it's more to understand where they are coming from and making sure they will be okay in the housing, but people don't get into permanent housing without some level of knowing who they

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are and so forth. >> and in the stablization rooms, again, we want to make it as low threshold as possible to get people off the streets. but the kind of supports you have to provide also go up with regard to that. so, for example, everyone in a stablization room must agree to access the stablization room to agree to have case management as part of it. so it's not simply a room that you get and no strings attached, you have to agree to participate in our case management program and that generally means meeting with your case manager once a week whether it's in the room, whether it's in our office, whether it's in a cafe somewhere, wherever it's convenient and appropriate. on top of that we also have room monitors that by design are other case managers so there is a cross check. so these rooms are things that you don't have tenancy rights to, they are like treatment spaces. so our room monitors will go once a week and check these

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rooms, 1, it make sure the condition of the room is okay and if the person happens to be there, that the person is okay. but the person is really the responsibility of the case manager and the room is the responsibility of the room monitor. on top of all this, we have connections, we maintain good relations with the hotel owners and the hotel managers because they are taking on a bit of risk having us bring in people that they have not cleared. so whenever there are difficulties, issues that arise, we know that we need to support them with respect to possibly moving that individual to another room, to another hotel, and since we have 8 hotels we have some luxury to do that. secondly, that person may need to perhaps be in a shelter bed for a little while, while there's 24/7 staff coverage there, to help them with whatever issue is going on. so it's a very flexible program and we provide a lot of support.

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and because people don't have tendency rights to those rooms, people sign agreements saying we will observe hotel rooms otherwise we will be asked to leave. it does come to that, but sometimes. we try to make provisions for them to go to a shelter situation or possibly another hotel. we try our best it keep people in as safe a situation as we can but obviously there is no perfect situation. if there is assaultive behavior we have to ask people to leave. there are times we have had to use san francisco police department for emergencies. in 8 years we have had thousands of these rooms we have had to involve the police officers 5 or 6 times, literally. people are very grateful to be in these rooms, people are very happy we are providing the support we are providing. people tend to be on their best behavior. in fact, sometimes if people have

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a history of eviction this is a way they can demonstrate i can do well in this environment. we get letters from hotel management says, no, no, this person did well, they were perfectly fine. we use that as a way to get people back in permanent housing. but we want to keep the threshold as low as possible to help people who have been on the streets sometimes for years to get into housing. >> (inaudible). >> denise, you had a xwe. >> i will thank you both for being here. i was curious, i want to hear from the client perspective, what kind of feedback do you get from your clients that go through this program? >> i guess we can address it both ways. >> yes, whoever, thank you. >> for the stablization program overwhelmingly it's a positive response. people are happy to have a room that, we

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ask paepl to save up money but they don't have it pay for the room. there are complaints, there are complaints about bedbugs, there are complaints about people in the space using drugs and alcohol. these are private hotels and we don't have control over every single unit in the hotel. there are people that come into the hotel to sell drugs. this is a reality in the area we're talking about. there are neighbors that are using and it's tempting it use with them. we don't have as much control over the situation as we would like, but at the same time if you want to expert more control then you have to have a higher bar. so it's a dynamic that we struggle with all the time. but by and large, over 95, 97 percent of people are extremely happy to have a space that they can actually, they get a key, they can lock the door, they can have a place that's private for them and a place where they can store their belongings and

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just feel safer. overwhelmingly it's a positive response but by no means is it perfect. >> i would say for the permanent housing, you know, 97 percent or 98 percent of the people are extremely happy and i mean we have a much easier environment than what raj is dealing with in the sense that we have our support services on site, we have 24 hour desk clerking, we run the show. and so, you know, certainly issues come up and people become dissatisfied and want to laefrb or want to move and so forth, but i'd say the norm is that people become tearful and kind of a little overwhelmed when they are moving into a place like the richardson and what that says about who they are and that they do deserve a place to live like this that doesn't smell, that is light, that is clean, and in most cases it's, you know, b